Adult Ascaris Worm Passing from the Mouth

Ascaris lumbricoides is one of the most widespread human infections. Adult Ascaris worms inhabit the small intestine and themselves cause little disease in their normal habitat, except when there is heavy infection leading to intestinal obstruction. Wandering ascarids may reach abnormal situations when they migrate through the ampulla of Vater causing biliary obstruction with cholangitis and/or pancreatic necrosis. 1 Wandering ascarids occasionally pass from the nose or the mouth during vomiting. We report the case of a 36-year-old Senegalese man admitted to the emergency room after being hit by a bus in Dakar. He had an orbital hematoma and rib fractures. The patient was admitted overnight for observation, and had frontal pain with nausea, vomiting, and mild confusion. A female adult Ascaris worm was observed to exit the mouth ( Figure 1 ). A computed tomography scan revealed a subfrontal extradural hematoma, successfully managed by the local neurosurgical team. At discharge, the patient was treated with mebendazole.